13 December 2008

Dr Grumble knows the identity of only one of the anonymous UK medical bloggers. There was a time when Dr G felt that he wanted or needed to know who these people were. Now he is content to know them just by their blogging names. It would be sad not to know that you actually were or had been a friend of one of these people and that is why Dr Grumble did eventually unmask himself to one particular top medical blogger. As it turned out it seems we do not know each other. But that doesn't matter because we are blogging friends.

People learn to trust you by your blogging. That is how they know you. They feel that they are thinking in similar ways and that earns you some respect in their eyes. One blogger told Dr Grumble something that was very personal, something that was very hard for her to talk about. Perhaps it was something she did not mention much, if at all, to people closer to her than Dr Grumble. Dr Grumble was touched and flattered. It brought home to him the closeness of the blogging fraternity. To some extent he even wonders if anonymity can bring a frankness and closeness that is more difficult in a face-to-face encounter.

The blogging community is getting even closer because we are now communicating with each other away from the blogs in emails. Dr Grumble's email address is not even on the blog. It never has been. Somehow it has got around and he is being included in some email discussions which are addressing important issues. There is something very wrong when medical bloggers feel there is a need to conceal their identity from each other and discuss things like freedom of speech and the undermining of free thinking. And whether there is somebody in some senior position with a sinister objective or whether the goings-on are all cock-up rather than conspiracy.

Dr Grumble has worked outside the NHS. He has seen a lot of what is happening in the NHS happening elsewhere. It is a phenomenon driven by a blind management mantra that is sweeping the world. Some of what these people spout is nonsense but it is difficult to tell them so. In the summer Dr Grumble read a book about markets. Like most such books it repeatedly extolled the virtues of markets. Dr Grumble accepts that there was quite a lot of truth in the book but he does not approve of the uncritical worship of markets. Dr G has always taken the view that markets have their weaknesses. An earlier post on this very topic was never published. Grumble thought that even the blogging fraternity might not be ready for his views. You see, not so very long ago, it was heresy to suggest that those people in the City who run markets were not actually creating anything useful for society. But that is what Grumble was saying to himself along with criticism of bankers and their unwise lending. A few months later and Grumble's avant garde thinking is already passée. Everybody is thinking the same way. It's an odd world. Why was nobody prepared to speak out before?

In the management book Dr Grumble read there was criticism of doctors and other professionals with their cartels or closed shops. The implication was that this prevents the market working and that what you need is deregulation to allow the market to be opened up to all comers. This, of course, is the standard mad mantra. This was the rotten thinking that led to the banking crisis. This is the very same catechism that is being followed as healthcare assistants replace nurses and nurses replace doctors as they are propelled up the skills escalator. These malignant innovations have all come from the management gurus. But these smart-clad know-alls do not actually know all. We all know that they know very little. But nobody ever calls their bluff. It's like the City and the bankers. We all knew but nobody ever said anything.

The regulation of doctors is there to protect the public not doctors. Just as the regulation of banks should have protected the public. Medicine is not just regulated to prevent non-doctors doing a doctor's job. Cosy cartels are not what it's about. After all the regulation even prevents doctors doing doctors' jobs. What does this riddle mean? Well, Dr Grumble could not just set up as an NHS GP. Nor could a GP become a Dr Grumble. When Dr Grumble goes to his GP he wants to know he is seeing a doctor who has been trained to do the job. Perhaps Joe Public thinks any doctor who has been through medical school would have enough knowledge to be a GP but it is not the case any more than a GP could do a heart transplant. And for heart transplants you do not just need a surgeon. You need an anaesthetist and intensive care doctors and even physicians to tell the surgeon that a transplant is the only way forward. And there are lots of highly skilled nurses and technical staff needed all along the way. Each has their own expertise. Each has a vital and important role. Each task needs the right person for the right job. There's nothing new about this (Smith, A). So why are the malignant management gurus telling us otherwise?

As for markets in medicine, Dr Grumble is not at all sure that they work. The public may like more and more tests and scans and screening and be prepared to pay but that is not necessarily good for them. Yet in a market system there may be pressure for high tech solutions. And if you are a doctor being paid for providing high tech solutions then high tech solutions is what you will get whether it is good for you or not. That's the way of the market.

So who is driving the rotten thinking that pervades our organisations? Where does all this nonsense come from? Why is the same madness appearing everywhere? How can it be that so many are singing from the same rotten hymn sheet? Who is responsible for pedalling these insidious false beliefs? Are we being taken over by some mad malign evil sect? Sometimes it seems like it. It really does.

Posted by
Dr Grumble

3 comments:

Anonymous
said...

evil sect? - look no further than capita - and the tentacles it has.........